Failure modes in stereotactic radiosurgery. A narrative review

Area of Science:

• Radiotherapy
• Medical Physics
• Radiation Oncology

Background:

• Stereotactic radiosurgery (SRS) demands high precision, making workflow failures critical due to high radiation doses.
• Failure Mode and Effects Analysis (FMEA) is a key tool for identifying and mitigating risks in complex medical procedures.

Purpose of the Study:

• To identify the riskiest failure modes (FMs) in the SRS process.
• To determine the stages where these FMs most frequently occur.
• To review strategies for mitigating identified risks in SRS.

Main Methods:

• A narrative review of published FMEA data related to SRS was conducted.
• Literature search performed in PubMed and Scopus, including 7 eligible articles.
• Analysis of FMEA data from 9 radiotherapy departments (4 community, 5 academic).

Main Results:

• 54 high-risk FMs were identified within the SRS process.
• Treatment planning (18 FMs), treatment delivery (12 FMs), and consultation/patient registration (10 FMs) were the riskiest stages.
• Contouring, medical records review, target reirradiation, and patient positioning were common failure points.

Conclusions:

• Critical FMs can occur at any stage of SRS, highlighting the need for continuous risk assessment.
• FMEA analysis provides valuable insights for improving safety in SRS and other radiotherapy techniques.
• Findings support proactive risk management and learning from inter-institutional experiences in radiotherapy facilities.